Eur Clin Respir J. 2015 Dec 10;2:28245. doi: 10.3402/ecrj.v2.28245. eCollection 2015.
Evaluation of a combined MxA and CRP point-of-care immunoassay to identify viral and/or bacterial immune response in patients with acute febrile respiratory infection.
European clinical respiratory journal
Robert Sambursky, Nathan Shapiro
PMID: 26672961
PMCID: PMC4676840 DOI: 10.3402/ecrj.v2.28245
Abstract
BACKGROUND: Challenges in the clinical differentiation of viral and/or bacterial respiratory infection lead to the misappropriation of antibiotics and increased healthcare costs. A tool to facilitate rapid and accurate point-of-care (POC) differentiation is needed.
METHODS AND FINDINGS: A prospective, single center, blinded, observational clinical trial was conducted at Beth Israel Deaconess Medical Center from December 2012 to August 2013 to determine the accuracy of a POC immunoassay to identify a clinically significant immune response to viral and/or bacterial infection. Sixty patients with acute febrile respiratory infection (19 pharyngitis and 41 lower respiratory tract infection [LRTI]) were enrolled. Participants provided fingerstick blood for immunoassay testing (myxovirus A [MxA] and c-reactive protein [CRP]) and four oropharyngeal samples for viral PCR and routine bacterial cell culture. A venous blood sample was collected. An ELISA was used to measure CRP and MxA. Paired serological testing was used to confirm atypical bacteria. A urine sample was provided for Streptococcus and Legionella antigen testing. Patients with suspected LRTI had sputum and blood cultures, chest X-ray, and WBC count measured. Viral infection was confirmed if oropharyngeal PCR was positive for viral pathogens. Bacterial infection was confirmed in positive throat or sputum cultures. Elevated immunoglobulin M antibodies or twofold increase in IgG antibodies between acute and convalescent phase indicated atypical bacteria. Positive Streptococcus or Legionella urine antigen assays also confirmed bacterial infection. The immunoassay correctly categorized subjects as 92% (22/24) negative, 80% (16/20) with bacterial infection, and 70% (7/10) with viral infection.
CONCLUSIONS: The interplay between an MxA value and a semi-quantitative CRP value can aid in the differentiation of infectious etiology. In isolation, neither MxA nor CRP alone is sensitive or specific. However, the pattern of results in a rapid immunoassay provides a sensitive and specific method to differentiate acute febrile respiratory infections. This diagnostic information may help reduce antibiotic misuse and resistance and lower healthcare costs.
Keywords: CRP; MxA; bacteria; immune response; immunoassay; point-of-care; respiratory infection; virus
References
- J Virol Methods. 1998 Feb;70(2):183-91 - PubMed
- J Med Virol. 1981;8(3):161-7 - PubMed
- Br J Gen Pract. 2003 May;53(490):358-64 - PubMed
- Pediatr Infect Dis J. 2010 Aug;29(8):731-5 - PubMed
- Fam Pract. 2009 Feb;26(1):10-21 - PubMed
- J Clin Lab Anal. 1990;4(3):231-5 - PubMed
- J Med Microbiol. 2014 Mar;63(Pt 3):441-52 - PubMed
- Ann N Y Acad Sci. 1982;389:406-18 - PubMed
- Pediatrics. 2005 Oct;116(4):826-32 - PubMed
- Clin Chem Lab Med. 2005;43(4):438-40 - PubMed
- Pediatr Res. 2006 Dec;60(6):770-4 - PubMed
- Clin Chem. 1997 Nov;43(11):2064-75 - PubMed
- Clin Infect Dis. 2005 Aug 1;41(3):345-51 - PubMed
- Scand J Prim Health Care. 2000 Mar;18(1):39-43 - PubMed
- J Med Virol. 1999 Dec;59(4):547-51 - PubMed
- Acta Radiol. 2002 Mar;43(2):159-63 - PubMed
- Pediatrics. 2007 Aug;120(2):e410-5 - PubMed
- Acta Paediatr. 1996 Feb;85(2):163-7 - PubMed
- J Virol. 1992 Aug;66(8):4705-9 - PubMed
- J Clin Microbiol. 1998 Feb;36(2):539-42 - PubMed
- Br J Gen Pract. 2013 Nov;63(616):e787-94 - PubMed
- Pediatrics. 2014 Mar;133(3):e538-45 - PubMed
- Allergy. 2001 Sep;56(9):895-8 - PubMed
- Chest. 1995 Nov;108(5):1288-91 - PubMed
- Paediatr Respir Rev. 2013 Mar;14(1):38-45 - PubMed
- BMC Infect Dis. 2012 Jun 12;12:134 - PubMed
- Eur Respir J. 1997 May;10(5):1125-9 - PubMed
- Eur J Clin Microbiol Infect Dis. 1999 Sep;18(9):665-8 - PubMed
- N Engl J Med. 1993 Nov 11;329(20):1437-41 - PubMed
- Clin Infect Dis. 2010 Jan 15;50(2):202-9 - PubMed
- J Microbiol Immunol Infect. 2010 Jun;43(3):222-7 - PubMed
- Scand J Prim Health Care. 1992 Sep;10 (3):226-33 - PubMed
- J Med Virol. 2002 Mar;66(3):417-20 - PubMed
- J Clin Microbiol. 2011 Jul;49(7):2631-6 - PubMed
- J Virol. 1991 Feb;65(2):968-71 - PubMed
- Eur Respir J. 2002 Nov;20(5):1254-62 - PubMed
- Pediatr Res. 1997 May;41(5):647-50 - PubMed
- BMJ. 2005 Jul 2;331(7507):26 - PubMed
- Ann Emerg Med. 2001 Jun;37(6):690-7 - PubMed
- J Clin Lab Anal. 2012 May;26(3):174-83 - PubMed
- JAMA. 2010 Feb 3;303(5):418; author reply 419-20 - PubMed
- J Infect. 2012 Dec;65(6):490-5 - PubMed
- Clin Infect Dis. 2004 Jul 15;39(2):206-17 - PubMed
- Arch Intern Med. 2008 Oct 13;168(18):2000-7; discussion 2007-8 - PubMed
- J Immunol. 1993 Mar 1;150(5):1715-26 - PubMed
- Clin Infect Dis. 2005 Aug 15;41(4):490-7 - PubMed
- Chest. 1995 Apr;107(4):1028-31 - PubMed
- Am J Med. 2008 Mar;121(3):219-25 - PubMed
- J Clin Microbiol. 1993 Jan;31(1):111-7 - PubMed
- Scand J Infect Dis. 2008;40(9):715-20 - PubMed
- N Engl J Med. 2003 Apr 17;348(16):1546-54 - PubMed
- Cytokine. 2009 Jul;47(1):65-8 - PubMed
- Br J Gen Pract. 2001 Dec;51(473):998-1000 - PubMed
- J Virol. 1989 Jun;63(6):2616-22 - PubMed
- Clin Chem. 1999 Apr;45(4):478-85 - PubMed
- J Clin Pathol. 1979 Dec;32(12):1253-6 - PubMed
- JAMA. 2009 Sep 9;302(10 ):1059-66 - PubMed
- Ann Intern Med. 2003 Jan 21;138(2):109-18 - PubMed
- J Pediatr. 2009 Mar;154(3):396-400, 400.e1 - PubMed
- J Infect Dis. 1990 May;161(5):982-7 - PubMed
- Pediatr Allergy Immunol. 2003 Oct;14(5):363-70 - PubMed
- Am J Respir Crit Care Med. 2008 Jan 15;177(2):208-18 - PubMed
- N Engl J Med. 1988 Aug 18;319(7):397-400 - PubMed
- Mayo Clin Proc. 1975 Jun;50(6):339-44 - PubMed
- Am J Med. 2004 Apr 15;116(8):529-35 - PubMed
- BMC Fam Pract. 2007 Mar 29;8:15 - PubMed
- BMJ. 2009 May 05;338:b1374 - PubMed
- Arch Dis Child. 1986 Jan;61(1):24-9 - PubMed
- Influenza Other Respir Viruses. 2013 Jul;7(4):567-73 - PubMed
- JAMA. 2010 May 26;303(20):2051-7 - PubMed
- J Pediatr. 1992 Jan;120(1):22-7 - PubMed
- Pediatr Int. 2006 Feb;48(1):54-7 - PubMed
- Pediatrics. 2015 Apr;135(4):e985-93 - PubMed
Publication Types